COLLEGE OF THE SISKIYOUS FOUNDATION, 800 COLLEGE AVENUE, WEED, CA 96094
OFFICE: 530-938-5373 FAX: 530-938-5570 TOLL-FREE: 888-397-4339
Email: foundation@siskiyous.edu Web: www.siskiyous.edu/foundation/
Foundation Board of Directors: Dawna Cozzalio – President, Rennie Cleland – Vice President, Dawnie Slabaugh – Secretary, Darlene Melby
– Treasurer, Greg Messer – Immediate Past President, Sue Boston, Carol Cupp, Margaret Dean, Bruce Deutsch, Ronda Gubetta, Amy Lanier,
Denny Sbarbaro, Stephen Schoonmaker, Bob Winston, Linda Romaine, David Clarno,
Karen Copsey, Mark Healy, Logan Smith, Ron Slabbinck, Denise Mannion, Susan Westphal, David Gault, Wes Dutt
The COS Foundation supports the mission and values of the College of the Siskiyous by fostering community relationships and
raising funds to enhance exceptional learning environments.
Employee Payroll Deduction Form
I authorize College of the Siskiyous to deduct from my regular salary the amount of $____________ per month and
transmit these deductions to the COS Foundation. Please designate my gift to the following:
General Fund Student Emergency Fund Eagle Booster Club (COS Athletics)
Siskiyou Promise Scholarship of Choice (specify)
Or state your preferred designation here:
This authorization shall remain in effect until modified in writing by the undersigned.
Print Name: COS S Number: Social Security #:
Signed: Date:
Preferred Mailing Address:
Thank you for your support of COS and Students!
Yes, I give permission for the COS Foundation to use my name as a contributor.
No, I prefer my name remain confidential.
**Donations are tax-deductible and you will receive a contribution statement at the year-end.
***Please return completed form to Kelly Groppi in the COS Human Resources Office. Once processed, you will be
provided a copy for your own records.
